Despite the clinical impression that foot disorders are a common cause of falls and adverse events in older persons, little population-based data exist to support this view. Foot disorders are often overlooked as significant potential causes of falls and little work has evaluated significant mediators, such as balance or gait in older persons. Both falls and foot disorders represent major public health problems that will only increase in importance as the population ages. We propose to examine the impact of specific foot disorders upon falls, and further to evaluate whether balance or gait affect this relation. We will link a comprehensive assessment of foot disorders to observed falls over a two-year follow-up, as well as to the observed physical performance, balance and gait measures that might modify the relation. Our 3 specific aims of this project will examine the longitudinal relations between 1) foot disorders and falls, 2) foot disorders and falls considering a pathway via poor balance, 3) foot disorders and falls, considering a pathway via impaired gait, and a secondary aim exploring the relation between footwear and falls. It is significant to examine intervening variables, or mediators, as they may clarify the nature of the relation between foot disorders and falls, and also since they are potential targets for future interventions. No other cohort has linked detailed information on foot disorders in elders to comprehensive longitudinal falls information and no study thus far, has examined the roles of balance, gait, or footwear in an population evaluation of foot disorders and falls. The proposed study will provide essential information on associations of keen interest both to clinical medicine and public health in 'he field of aging. Results will help us to design future interventions, such as foot care, shoes and specific devices to reduce the risk of falls among elderly people. This project will make extensive use of the recruitment resources and data collection from an already funded program project grant (Principal Investigator: L. Lipsitz, Grant # AG04390, 7/01/04 - 06/30/08, "HRCA/Harvard Research Nursing Home"). Based on preliminary data, this study will provide new and significant information about the role of foot disorders upon new falls in elderly men and women over a two-year follow-up. A greater understanding of foot disorders in older individuals may lead to better understanding of the strategies to prevent falls.